Duration for Salvage Radioteraphy after RP

[Bmhk]

Hi Guys,

I guess it may vary from person to person, but in general, how long (days/sessions/shot) would you recommend to receive radiotherapy for the following situation;

Before RP PSA was 14

Patalogy report specified; pT3aN1M0, Gleaseon 7 (4+3), Pattern 4 rate %60, Grade Group 3

Surgical margin is positive.

After RP PSA was 0.59 and ADT has begun (Lupron) 3 months ago.

One of the RO recommend minimum 40 sessions IMRT (8 weeks for only workdays) the other recommend 25 session is enough....

Really confusing I do need your advice.

Thanks.

[Tall_Allen]

25 sounds good to me during the pandemic. Whole pelvic and 2-3 years of adt because of the N1. This explains about doing it in fewer sessions - it's called "hypofractionation"

prostatecancer.news/2016/08...

[Justfor_]

There is a biological equivalence of the product (number fractions x dose per fraction).

Which one of the two to prefer, has to do with the expertise, personnel and available equipment. Fewer fractions at elevated doses must be more tightly aimed, attended, controlled, etc, compared to more fractions at reduced doses. Any mishap in the first case incurs more damage to the patient. Consequently, you have to assess the full setup of the two versions.

Apart from COVID you have another, equally important reason for delaying SRT: Surgery healing and improved continence. You are on ADT now, so you can take your time.

Finally, my standard advice before SRT is to take a PSMA PET/CT test and find an RO that can adjust your treatment to any findings or lack of them there in.

[George71 in reply to Justfor_]

I agree with Justfor_ , I was considering radiation also and my RO recommended 35 sessions and only the 2 chains of lymph nodes nearest the prostate. 35 sessions for reasons Justfor_ sited. Like you, I had N1 at the time of surgery and am nearly 5 years out PSA was 0.03 now 1.37. Taking nothing but Avodart every other day. No evidence in lymph nodes showing from PSMA scan. only a quarter inch big questionable spot in SV area near prostate bed ... Also I would think hard about whole pelvic radiation as opposed to the 2 chains nearest the prostate. Whole pelvic can cause lifetime edema issues. You are doing this hopefully to live decades --- you certainly don't want to have that disaster to live with for life if you can help it ... it is also questionable if it even helps ... see link below ... and lastly -- new treatments are coming on all the time in 4 or 5 years immuno therapy will likely make big strides and you will spare your self a lot of co-morbidity issues.

youtube.com/watch?v=HkopU_7...(Not working as expected?)

One of the interesting points was involving RT of prostate bed vs RT of prostate bed plus whole pelvic lymph nodes in lymph node positive patients --- no benefit and no over all survival benefit to RT lymph nodes... their trial results does not support radiating lymph nodes even in lymph node positive patients.

[George71 in reply to George71]

The video doesn't seem to work .. but you can see a post I made on here 2 days ago titled

"External Beam Radiation Therapy for High Risk/Locally Advanced PCa: The Shifting Landscape"

the video works there.

You can go to youtube and type in the title:

"External Beam Radiation Therapy for High Risk/Locally Advanced PCa: The Shifting Landscape"

[Bmhk]

Hi guys, thanks for your shares. PSMA PET scans was clear 6 months ago. I guess there is no need to repeat in 6 months. (Do you?) I watched the video, it also noticed that ADT + RT has better result compared to only ADT, so the question is what is the best time to start RT after RP. All doctors recommend to start RT when urinate problems decreases or disappers (Generally 6 months after RP). George71 I guess you don't agree with this idea and suggest monitoring PSA. Tall_Allen Could u also let us know, what is best time to start RT after RP. (If Covid is not a issue) Thanks.

[j-o-h-n]

HERE I GO AGAIN....

I've posted this before so to those people who have already seen this please forgive me.

I had 8 weeks of salvage radiation to "the bed". 5 days a week (not weekends) for 8 weeks minus 1 day for a total of 39 sessions at MSKcc. The actual radiation was like getting an x-ray by my dentist. I never had any side effects during the whole 39 sessions.

However 2 years later my left urinary tract was "fried" as per my urologist (or from passing prior kidney stones he was not sure). So I had to have a urinary stent placed up my urinary tract (through my willy which is really nothing - sounds terrible but it's nothing) to aid in passing my urine (which was never a problem anyway). So I had stents in and out every three months for many years and now I'm stent free, However today 15% of urine from left kidney and 85% from right kidney, but not a problem.

So make sure you get a good radiologist. Also I don't know if this would apply to you but guys here recommend SPACEOAR HYDROGEL to be inserted for protection of parts of your body. Make sure you ask your R.O. about the spaceoar and make sure you ask here on this forum before getting fried.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 09/22/2020 6:47 PM DST

[SPEEDYX in reply to j-o-h-n]

You are forgiven!

[SPEEDYX in reply to j-o-h-n]

Colossians 3:13....The Who a quick way!

[Fanger1 in reply to j-o-h-n]

Yeah, how about the Lidocaine injection to numb the site prior to SpaceOar! Woe Nelly🙉

[j-o-h-n in reply to Fanger1]

They're experimenting with a new numbness procedure....it's a pit bull bite instead...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 09/22/2020 8:08 PM DST

[Fanger1 in reply to j-o-h-n]

I'll take the 27 gage instead....just lie back, put your feet here and try to relax. 🙄

[j-o-h-n in reply to Fanger1]

And remember to smile.... cause you'll be on Youtube.......

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 09/22/2020 9:53 PM DST